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A Psychoeducational Approach to Improving College Student Mental Health

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A Psychoeducational Approach to Improving College Student Mental Health A PSYCHOEDUCATIONAL APPROACH TO IMPROVING COLLEGE STUDENT MENTAL HEALTH PROFESSIONAL DISSERTATION SUBMITTED TO THE FACULTY OF THE SCHOOL OF PROFESSIONAL PSYCHOLOGY WRIGHT STATE UNIVERSITY BY HARLAN KEITH HIGGINBOTHAM JR., M.A. IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PSYCHOLOGY Dayton, Ohio September, 2013 COMMITTEE CHAIR: Robert Rando, Ph.D., ABPP Committee Member: Jeffrey Allen, Ph.D., ABPP Committee Member: Daniela Burnworth, Ph.D. WRIGHT STATE UNIVERSITY SCHOOL OF PROFESSIONAL PSYCHOLOGY June 27, 2012 I HEREBY RECOMMEND THAT THE DISSERTATION PREPARED UNDER MY SUPERVISION BY HARLAN KEITH HIGGINBOTHAM, JR. ENTITLED A PSYCHOEDUCATIONAL APPROACH TO IMPROVING COLLEGE STUDENT MENTAL HEALTH BE ACCEPTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PSYCHOLOGY. _______________________________________ Robert Rando, Ph.D., ABPP Dissertation Director _______________________________________ La Pearl Logan Winfrey, Ph.D. Associate Dean Abstract Mental health problems among the college population continue to increase in terms of frequency and severity. At the same time, the number of high school graduates who enroll in institutes of higher learning is also increasing making the college years an ideal opportunity to address existing and emerging mental and psychological challenges. Traditional counseling center services--while shown to be effective--are not appropriate for all students and are too resource intensive to meet the full need of the college population. Creative strategies are necessary to address the growing need for mental health services among college and university students that are resource efficient, can reach a broader range of students by overcoming barriers to treatment, can effectively address current mental health concerns, and that effectively prepare students for the mental and emotional challenges they will face in today’s world. Available research supports the application of several psychoeducational approaches to the treatment of common mental health concerns as well as in the development of resiliency for the protection against future challenges. This project provides a potential solution to the growing need for mental health services by combining proven psychoeducational approaches into a semester class under the umbrella of effective stress management. This class integrates physiological and psychological understandings of stress and stress management with evidence-based skills including relaxation techniques, problem- solving, mindfulness, cognitive restructuring, and assertiveness shown to be effective not only in the treatment of stress but also in the treatment of common mental illnesses such as anxiety and depression. Further, this course encompasses a set of skills consistent with the positive psychology literature on the development of resilience. An instructors iii guide, course slides, course syllabus, and recommendations for readings, homework, and practices are provided and organized into separate modules to facilitate adaptation to various formats. iv Table of Contents Literature Review.............................................................................................................. 10 Prevalence of Mental Disorders among College Students ............................................ 10 Help-Seeking Behaviors among College Students........................................................ 23 Impact of Mental Health Issues on Measures of Student Success ................................ 32 Summary of Mental Health Issues in College Students ................................................ 41 Interventions .................................................................................................................. 42 Summary ....................................................................................................................... 62 Method .............................................................................................................................. 64 Class Overview and Rationale ...................................................................................... 64 Class Material Sources .................................................................................................. 65 Materials ........................................................................................................................ 66 Results – Course Products ................................................................................................ 67 Discussion ......................................................................................................................... 69 Appendix A - Course Guide ............................................................................................. 73 About This Course ........................................................................................................ 73 Course Goal ................................................................................................................... 74 Course Objectives ......................................................................................................... 74 Preparation for Instructors ............................................................................................. 76 Modification and Tailoring of Course ........................................................................... 76 Thoughts about Grading ................................................................................................ 77 Ideas for Student Participation ...................................................................................... 78 Maintaining Role Boundaries........................................................................................ 79 Dealing with Disruptive or Severely Activated Students.............................................. 80 Teaching Points ............................................................................................................. 81 Detailed Outline .......................................................................................................... 117 Appendix B – Course Syllabus ....................................................................................... 123 Course Title ................................................................................................................. 123 Course Description ...................................................................................................... 123 Course Objectives ....................................................................................................... 123 v Course Resources ........................................................................................................ 124 Course Outline............................................................................................................. 124 Appendix C – Course Slides ........................................................................................... 125 References ....................................................................................................................... 196 vi A Psychoeducational Approach to Improving College Student Mental Health The tragic shootings on April 16, 2007 at Virginia Polytechnic Institute and State University and February 14, 2008 at Northern Illinois University along with many attempted and completed suicides have caused concern regarding the mental health of college students and the mental health services of American institutions of higher learning (Hunt & Eisenberg, 2010; Kay, 2010; Voelker, 2003). While the percentage of American children who pursue postsecondary education continues to rise (NCES, 2010), advances in early diagnosis, evidenced-based psychotherapies, and psychiatric medications are enabling children with psychiatric disorders to attend and succeed in postsecondary education who before would not have had the attention span, motivation, or emotional capability to handle the academic and social challenges (Hunt & Eisenberg, 2010; Kay, 2010). Recent studies also suggest that the number of college and university students who report symptoms of mental disorders continues to rise. One source of mental health trends among college students is the bi-annual National College Health Assessment (NCHA) administered from spring 2000 through spring 2008 and the revised NCHA II administered by the American College Health Association (ACHA). Higginbotham and Rando (2010) analyzed the results of the three surveys for the NCHA II and found the percentage of college students reporting impediments to academic performance due to stress to be 27.2%, sleep problems 19.5%, anxiety 18.5%, depression 11.4%, and relationship difficulties 10.7%. Students also reported experiencing within the past 12 1 months overwhelming anxiety (48.6%), seriously considering suicide (6.1%), self- injurious behavior (5.2%), and attempted suicide (1.2%). The lifetime rate of depression among the students was reported to be 17.7%. Higginbotham and Rando (2010) also compared results of the NCHA over the 17 versions of the survey. They found that students who reported experiencing an anxiety disorder over the past year rose 0.9% a year from 6.7% in spring 2000 to 13.2% in spring 2008 and those experiencing depression rose 0.2% per year from 16.4% in spring 2000 to a high of 20.9% in fall 2005. The number of students indicating that depression and anxiety had some impact on their academic performance rose 0.9% per year (11.3% to 16.1% over the period
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